Estimated annual impact: –$5B (mid‑case), range –$20B to +$10B

Medicare Comprehensive Care and Fair Premiums Act — expands benefits, simplifies premiums, and reduces out‑of‑pocket costs for seniors

Summary

  • Purpose: Expand Medicare to include dental, vision, hearing, and full prescription coverage; eliminate IRMAA surcharges; waive premiums for middle‑ and lower‑income seniors.
  • Net fiscal impact (annual): Low: –$20B | Mid: –$5B | High: +$10B
  • Primary beneficiaries: ~65M Medicare enrollees, especially seniors under $100k income.

Mechanism of costs & savings

  • Costs: Expanded dental/vision/hearing/prescription coverage (~$40–50B annually); waived premiums (~$15–20B revenue loss).
  • Preventive savings: Early care reduces ER visits and hospitalizations (potential $20–30B savings).
  • Prescription adherence: Eliminating cost‑sharing lowers long‑term chronic disease costs.
  • Administrative simplification: Removing IRMAA tiers and siloed Part D structures saves ~$5–10B annually.
  • Economic feedback: Seniors with lower out‑of‑pocket costs spend more locally, boosting tax receipts.

Assumptions

  • Baseline: Medicare spends ~$900B annually (2024).
  • Beneficiaries: ~65M, with ~55% under $100k income.
  • Dental/vision/hearing costs: ~$800–1,000 per beneficiary per year.
  • Prescription expansion: ~$500–700 per beneficiary per year, offset by reduced hospitalizations.
  • Admin simplification: 1–2% of Medicare spend saved.

Calculations

  • Low case: +$50B (new benefits) – $20B (waived premiums) – $30B (savings) = –$20B net.
  • Mid case: +$45B – $18B – $40B = –$5B net.
  • High case: +$40B – $15B – $65B = +$10B net.

Risks and mitigation

  • Trust Fund strain: Mitigate with general fund backstop, phased rollout, preventive savings tracking.
  • Political pushback: Emphasize no new taxes, receipts in preventive savings, elimination of waste.
  • Provider capacity: Adjust reimbursement rates, incentivize provider participation.

Measurement and reporting

  • KPIs: Out‑of‑pocket costs, ER visits avoided, hospitalization rates, prescription adherence, Trust Fund balance.
  • Cadence: Annual HHS report to Congress; public dashboards.

Bottom line

The Medicare Comprehensive Care and Fair Premiums Act delivers comprehensive benefits and simpler premiums for seniors. While it carries upfront costs, preventive care and administrative savings can offset or even surpass them, making this one of the few Medicare reforms that could both expand coverage and stabilize finances.